Assistive technology for operating nursing homes and other health care facilities

ABSTRACT

A facility for coordinating the safety care of a person is described. The facility receives sensor output indicating that the person has departed a place of repose. In response to this receiving, the facility establishes an alarm identifying the person, accesses a set of on-duty caregivers, and applies one or more precedence rules to establish a precedence among at least a portion of the set of on-duty caregivers. Until a caregiver has accepted the alarm, for each caregiver in the established precedence, the facility: causes a mobile device carried by the caregiver to render a message notifying the caregiver of the alarm and soliciting the caregiver&#39;s acceptance of the alarm; and allows the caregiver an interval of time of a first predetermined length in which to accept the alarm before proceeding to the next caregiver in the established precedence.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is related to the following applications, each of whichis hereby incorporated by reference in its entirety: U.S. ProvisionalPatent Application No. 62/572,373, filed on Oct. 13, 2017; U.S.Provisional Patent Application No. 62/572,379, filed on Oct. 13, 2017;U.S. Provisional Patent Application No. 62/580,928, filed on Nov. 2,2017; U.S. Provisional Patent Application No. 62/643,695, filed on Mar.15, 2018; and U.S. Provisional Patent Application No. 62/691,960, filedon Jun. 29, 2018. In cases where the present patent applicationconflicts with an application incorporated here by reference, thepresent application controls.

BACKGROUND

Nursing homes (sometimes known by other names, such as “care facilities”and “care homes”) are residential facilities that providearound-the-clock nursing care for elderly people (“residents,” or“patients”). Most residents have health issues that require regularattention. Many residents have limited mobility, and are prone to falls.Some residents suffer from communication deficits or dementia.

In a care facility, residents can be attended by nurses, nursingassistants, other caregivers, supervisors, and a variety of other staff.Such staff can be assigned based on the particular health needs ofindividual residents; a physical area of the facility in which eachresident primarily resides; or on a variety of other bases.

Conventionally, some residents are monitored to determine when theyleave their beds, such as residents who are prone to falls. When such aresident's weight leaves the mattress on their bed, an analog pressureswitch opens, causing an attached monitor device to emit a loud alarm inthe resident's room intended to alert a staff member that the residenthas left their bed, and may be at risk of a fall. The alarm may continueuntil a staff member arrives to check on the resident and cancels thealarm.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a network diagram showing a variety of components thatcommunicate as part of the operation of the facility.

FIG. 2 is a block diagram showing some of the components typicallyincorporated in at least some of the computer systems and other deviceson which the facility operates.

FIG. 3 is a user interface diagram showing a sample user interfacepresented by the facility in some embodiments to configure for aparticular user the conditions that will trigger an alarm or warning.

FIG. 4 is a display diagram showing a sample user interface presented bythe facility in some embodiments to permit a staff member to centrallycontrol the settings on one or more monitors.

FIG. 5 is a flow diagram showing a process performed by the facility insome embodiments to automatically infer alarm states and/or warningstates from data received about the resident from sensors of a varietyof types.

FIG. 6 is a flow diagram showing a process performed by the facility insome embodiments to use machine learning techniques to associate sensoroutputs proximate in time to explicit alarms with inferred alarm states.

FIG. 7 is a flow diagram showing a process performed by the facility insome embodiments to perform silent dispatch of a staff member inresponse to a resident alarm or warning.

FIG. 8 is a user interface diagram showing a sample user interfacepresented by the facility in some embodiments to allow a staff memberuser to specify a hierarchy among the staff for prompting staff membersto respond to resident alarms and warnings.

FIG. 9 is a user interface diagram showing a sample user interfacepresented by the facility in some embodiments to prompt a staff memberto respond to an alarm.

FIGS. 10A-10E are user interface diagrams showing a sample userinterface presented by the facility in some embodiments to collectinformation about a resident alarm or warning and its resolution fromthe staff member who responded to the alarm or warning.

FIG. 11 is a user interface diagram showing a sample user interfaceprovided by the facility in some embodiments to enable staff member userto configure alarm attributes for a particular resident.

FIG. 12 is a user interface diagram showing a sample user interfaceprovided by the facility in some embodiments to show the timing ofalarms and/or warnings in a particular care facility or area of a carefacility.

FIG. 13 is a user interface diagram showing a second sample userinterface provided by the facility in some embodiments to show thetiming of alarms, warnings, and special or other types of events thatoccur in a particular care facility or area of a care facility.

FIG. 14 is a user interface diagram showing a third sample userinterface provided by the facility in some embodiments to show thetiming of alarms, warnings, and special or other events in a particularcare facility or area of a care facility.

FIG. 15 is a displayed diagram showing a display presented by thefacility in some examples to reflect storage of the second user'sannotations.

FIGS. 16A-16F are diagrams showing an additional form of devicelocation-finding used by the facility in some embodiments.

FIG. 17 is a flow diagram showing a process performed at the facility insome embodiments to track and respond to the location of a resident.

DETAILED DESCRIPTION Overview

The inventors have recognized that nursing homes and health carefacilities of other types would benefit from additional technologicalassistance. Accordingly, they have conceived and reduced to practice asoftware and/or hardware facility to assist in the operation of one ormore health care facilities (“the facility”). In various embodiments,the facility provides information that enables more thorough, effective,and/or efficient operation of the health care facilities with respect towhich it is operated, facilitating data-driven decision making.

In some embodiments, the facility includes one or more high-performancemattress sensor pads that reports a pressure level—in some cases at eachof multiple points or regions on the pad. In cases where thismulti-point pressure information can be obtained from the pad, thefacility uses it to detect restlessness, the probability of future fallfrom bed; discern nature of bed departure; duration and time in place;sleep stage; and assess repositioning.

In some such embodiments, a circuit included in the pad enables the padto simulate the “open or closed” behavior of a more basic pad thatsimply closes a circuit between two conductors if a threshold weightlevel is exceeded. In particular, this circuit has much lower powerrequirements than the electrical relay that might otherwise be used.

In some embodiments, the facility uses a variety of other sensor typesto monitor the patient's location, position, and safety, such as wornresident tracking device; and/or a fixed motion sensor, proximitysensor, image sensor, and/or light sensor.

In some embodiments, the facility provides a mechanism that allows staffmembers to configure for each resident the conditions that trigger analarm. Examples of such conditions include entire resident weightdeparting bed and/or chair; partial resident weight departing bed and/orchair; explicit alarm activation by resident; failure to depart frombed, chair, and/or toilet for more than a threshold length of time;departure from bed/chair/toilet not followed by arrival atbed/chair/toilet within a threshold length of time; departure from roomor portion of room; departure from bed/chair/toilet without returning toa monitored surface for more than a threshold amount of time; etc.

In some embodiments, the facility automatically infers alarm states fromdata received about the resident from sensors of a variety of types. Insome embodiments, the facility uses machine learning techniques toassociate sensor outputs proximate in time to explicit alarms withinferred alarm states.

In some embodiments, the facility automatically infers warning statesreflecting probable imminent resident needs from data received about theresident from sensors of a variety of types.

In some embodiments, the facility responds to an alarm or warningcondition, such as a departure from bed, in a way that summons a staffmember without creating a sensory disturbance for that resident, or forother people nearby, such as by selectively prompting staff membersusing portable devices carried by them. In some embodiments, thefacility uses rules and associated information to choose the staffmember initially summoned, and to summon additional staff members untila staff member accepts the alarm. In some embodiments, the facilityprovides a mechanism that allows staff members to configure for eachresident which staff members are summoned for alarms raised for theresident, in some cases differently based on the type of the alarm.

In some embodiments, after a staff member accepts the alarm, thefacility conducts a survey with the staff member to collect informationabout the alarm and its resolution. In some embodiments, the facilitystores the collected information for further analysis, such as to assessresponse time and other staff performance metrics; infer informationabout the resident such as bathroom frequency/schedule; referralsuggestions in light of observed resident information; etc.

In some embodiments, the facility provides a mechanism that allows staffmembers to configure alarm attributes for each resident. Examples ofsuch attributes are silent/audible; visible/non-visible; volume level;duration; sound type; speech/non-speech; etc.

In some embodiments, the facility provides a visual user interface thatshows the alarms (or warnings, or alarms and warnings) that haveoccurred over time relative to a timeline. In various embodiments, theseare for a single, selected resident; a group of residents, such as thosewho reside in a particular area of the health care facility, or are in aparticular category of residents based on, for example, their careneeds; or all of the residents in the health care facility.

In some embodiments, the facility provides a mechanism that allows staffmembers to configure voice behavior cues for each resident to suggestactions to him or her, such as “wait by the bed” or “use your walker.”

In some embodiments, the facility tracks the physical location of someor more residents, and uses this information to assess whether anyresident has left or is in the process of leaving an area in which theyshould stay. In cases where a resident is, the facility automaticallygenerates an alarm or warning to cause the intervention of a staffmember. In some embodiments, the facility tracks the physical locationof staff members in the same or similar ways, such as to monitor theirperformance of rounds, alarm and warning responses, and otherresponsibilities that involve movement through the health care facility.

By performing in some or all of these ways, the facility assist theoperator of a health care facility to provide more consistent,personalized, and valuable care to its residents.

Also, in various embodiments, the facility provides important benefits,as follows:

The SURE® Monitors Patient Risks, Aids a Nurse's Response, and ProvidesReports and Documentation.

The SUREnursing™ advisor monitors bed, chair, wheelchair, toiletpresence and unexpected movement to rise: It notifies a nurse when atimely response is needed.

The SUREnursing informatics are relevant to understanding, anticipatingand responding to patient needs. And reporting outcomes.

More, SUREnursing reports gives supervisors and managers at all levelsvaluable information they have never seen before about performance.

8 Ways the SUREnursing™ Advisor can Make a Difference

Enhanced Patient Care; Better Informed Individual Care; More ProactiveNursing Management; Better Nursing Collaboration; Better Records,Validation and Reporting; Better General Management; Reduction in WastedCost; and Expected Economic Impact.

Enhanced Patient Care

Quiet Notifications: Won't startle the resident, the roommate or thefamily members. Notifications are received on responder's handhelddevice, desktop, or laptop.

Facilitates Uninterrupted sleep.

Dignity: Located under the mattress or chair pad, it less likely toattract awareness or unneeded comment.

Comfort: Under mattress/chair pad location moves vinyl sensor away fromthe skin.

Validates each nurses response to a notification.

Better Informed Staff for Individual Care

Shift change dashboard reviews residents past 24-hour activity pattern.In case of incident, immediate documentation supports details of event.

Notifies designated unit nurses of risk events quietly on their digitaldevice.

Records nursing response to resident risk notification while documentingrelated nursing presence with the resident.

Escalates notifications to a second responder when the lead responder isbusy.

Lets each team member know who is responding.

Helps supervisors with patient care nursing time management by showingperiods of higher and lower nursing response activity.

In case of a fall, a questionnaire for the responder provides near timeevent information supporting further documentation and teamcollaboration on remedial actions needed.

Helps professional staff to assess dementia resident needs: toileting,hydration, pain, possible UTI, etc.

More Proactive Nursing Management

It starts shift with a computer screen dashboard for a unit or afacility of the last 24 hours of resident bed, chair or wheelchair riskactivity with an ability to drill down to specific time and resident.

Provides informatics for real time team collaboration and timely careplan adjustments.

Provides a view of nurses signed in to the SURE® system, and alerts to asupervisor if no one is signed in or confirms an intended notificationresponse in a timely manner.

Provides a desk top overview of SURE system units, availability,location, and functionality, i.e., plugged in, battery status, etc.

Notifies supervisors to residents past due for reposition.

Helps guide direct staff to better self manage time and work flow.

More efficient new-resident care due to immediate baseline data.

More comprehensive information to share with physicians and families.

Better Nursing Collaboration

Individualized data coupled with the professional intuitive skills ofthose closest to the resident or patient facilitates optimal decisionmaking on a real time basis.

Finding residents in wheel chairs in designated areas.

Facilitates the assignment of individual responsibility andaccountability.

Can help evaluations with individual performance information.

Better Records, Validation and Reporting

It starts the day with a computer screen dashboard showing of the last24 hours of resident risk activity and nursing response.

Helps guide nurse assignments and scheduling by nurse supervisors. Canfacilitate custom nursing assignments by specialty, patient need andpreference.

Validates daily charting for Medicare and Medicaid documentation.

Supports the screening results and confirms MDS coding.

More efficient new-resident care due to immediate baseline data.

More comprehensive information to share with physicians and families.

Better General Management

It starts the day with a computer dashboard of a facility, or group offacilities summarizing data by faculty and units with the user definedability to drill down to individual patients and moments in time. Showsfall sand number of notifications to reposition. Probable earlierawareness and better documentation for remedial action.

Validates daily charting for Medicare and Medicaid documentation.

Supports the screening results and confirms MDS coding.

More timely new-resident care planning due to immediate baseline data.

Better data for care plans and survey preparation.

Ever present ready information to share with physicians and families.

Better goal setting and QAPIs related to skin, falls and riskmanagement.

Supports the budget process.

Reduces Wasted Cost

Helps supervisors and DON's with nursing time management by showingperiods of higher and lower resident response activity, and relativelocation.

Provides a focused notification to allow one person to respond to analert, and escalation if the designated lead responder reports as busy.

With placement of an intelligent sensor pad under a mattress or chairpad time is saved: repositioning the pad; and cleaning the pad when ithas not been soiled.

Economic Impact

Creates awareness and documents unnoticed increases in carelevels—increased reimbursement.

Better records and validation>faster preparation of MDS—higher starratings>greater reimbursement>more admissions.

Better reputation in the healthcare network>more admissions>greaterrevenue.

Improve nursing efficiencies. Less wasted effort.

Improved patient outcomes can lead to more private pay referrals.

Better nursing management can lead to higher nurse retention.

Facility Components

FIG. 1 is a network diagram showing a variety of components thatcommunicate as part of the operation of the facility. While connectionsbetween these components are shown by unbroken lines, those skilled inthe art will appreciate that components may be connected by wiredconnections, wireless radio connections, optical connections, etc., ormultiple of these.

In some embodiments, the facility includes one or more pressure sensorpads 121, placed on or in or incorporated into a bed, a chair, a couch,a daybed, a wheelchair, a toilet seat, a toilet base, etc. In someembodiments, the pressure sensor pad incorporates a padding elementabove the pressure sensors, below the pressure sensors, or both.

In some embodiments, the pressure sensor pad has a calibration unit thatis permanently or semi-permanently integrated into the pad. In someembodiments, the calibration unit is detachable from the pad, such thatthe same calibration unit can be used with multiple pads, includingmultiple pads that are simultaneously deployed in multiple locationswithin the health care facility, or a series of pads that are deployedin the same health care facility location over time.

In some embodiments, the facility automatically resupplies pressuresensor pads to a health care facility based upon their predicted orsensed end of life. In some embodiments, the resupplied pressure sensingpads are labeled with the particular location in the health carefacility of the pad they are to replace, such as a particular room orbed number. In some embodiments, the resupplied pads are mailed inindividual packages that are designed to be reused to return the usedpad that has been replaced for refurbishing or disposal. In someembodiments, the operator of the facility charges the health carefacility a fixed periodic fee for each pad irrespective of when or howfrequently they are replaced.

These pressure pads communicate with a monitor device 110, which are insome embodiments provisioned at the level of one for each resident, onefor each pair of residents, one for each room, etc. The monitor devicecommunicates information from the pressure pad to a local server 140,where the facility analyzes and processes this information. For example,the local server may recognize in the communicated information an alarmcondition or a warning condition, which it uses to notify one or morestaff portable devices 132 of an alarm that requires response, in somecases via a cloud server 150. The staff portable devices can be, forexample, smart phones, tablets, smart badges or watches, etc. In someembodiments, the local server also communicates with the cloud server150 to notify staff members or for additional purposes, such as to loginformation for backup purposes; aggregate and analyze data collected bymultiple local servers at different locations; etc. In some embodiments,processing burdens are distributed between the local server and thecloud server on the basis of needed response time, such that tasks thatare needed to be performed with a small response time are performed onthe local server, while tasks that can tolerate longer response timesare performed on the cloud server.

In some embodiments, the monitor device also communicates withadditional nearby sensors, such as sensors in the same room: one or moremotion sensors 122; one or more proximity sensors 123; one or more imagesensors 124; one or more light sensors 125; one or more door contactsensors 126; one or more current or power draw sensors 127 for sensingthe level of current or power being drawn by an electrical deviceplugged into a particular outlet; and one or more third-party devices128 designed to report information to and/or through the facility andits network. Output from the sensors, too, is conveyed to the localserver, and the cloud server, and is there stored and analyzed toidentify alarm or warning conditions.

In some embodiments, the monitor device also interacts with the staffportable devices and/or resident tracking devices (such as a pendant orwatch worn by a resident) in order to track the location of staffmembers and residents, respectively.

In some embodiments, some or all of the pressure sensor pads used by thefacility are high-performance mattress sensor pads that reports apressure level—in some cases at each of multiple points or regions onthe pad. In various embodiments, these points or regions are arrayedlaterally, longitudinally, in a t-shape, or in a grid relative to thesupportive area of the mattress. In cases where this multi-pointpressure information can be obtained from the pad, the facility uses itto detect restlessness, the probability of future fall from bed; discernnature of bed departure; duration and time in place; and assessrepositioning. In some such embodiments, a circuit included in the padenables the pad to simulate the “open or closed” behavior of a morebasic pad that simply closes a circuit between two conductors if athreshold weight level is exceeded. In particular, this outputprocessing is performed using a diode network and a transistor, whichhas much lower power requirements than the electrical relay that mightotherwise be used.

In some embodiments, the high-performance pad incorporates a microcontroller (MCU) that has one or more Analog to Digital Converters(“ADCs”). Initialization: The MCU, coming out of its reset state, startswith a clean slate and has no knowledge of past pressures. In order toinitialize itself, the MCU takes a reading of the pad pressure. Thefollowing variables are then defined and all are set to the currentreading:

-   -   lastReading: Working value which always contains the last known        pad reading    -   averageReading: A rolling average of the last four reading to        provide data smoothing    -   recordHigh: Upper threshold representing the lowest pressure        recorded (dynamically adjusted) as calibrated by a user    -   recordLow: Lower threshold representing the highest pressure        recorded (dynamically adjusted)

Once initialized, the facility places the MCU into a sleep mode in whichit wakes up on a periodic basis, such as once per 256 milliseconds.

Wake Reading and Check: On wake the MCU performs the followingoperations:

-   -   Perform a new pad reading and set the lastReading variable to        this value    -   Set the averageReading=((3*lastReading)+averageReading)/4    -   If the lastReading is less than the recordLow then set        recordLow=lastReading

This updates all variables in order to be prepped for the remaininglogic. At this point, the MCU makes a decision if it has gathered enoughdata in order to execute the remaining logic or if it needs to go backto sleep; a newly initialized MCU will have arecordHigh=recordLow=averageReading, and if they aren't exactly equal,they are often very close in value, which creates an error condition. Inthis state a large enough range of pressures have not been recordedtherefor an in bed or out of bed cannot be determined, which causes thesystem to default to the failsafe deactivated condition. In order toadapt to different responsivenesses of pad materials, a hard upper limitis set to 2% of the total range from 0 to recordHigh. This allows asignal that is slowly approaching recordHigh without even reaching it tobe recaptured and encoded as an out of bed signal. This allows thedynamic calibration system to avoid endlessly adjusting to a very slowlydecaying signal that manages to keep within the Transitioning region.

Region Calculation: Once the MCU has determined the recordHigh andrecordLow values have diverged sufficiently, the facility executes thepressure regions logic. In this step, the MCU calculates three regions:

Region Calculation Percentage Deactivated High recordHigh 15%Deactivated Low recordHigh − ((recordHigh − 15% recordLow)*0.15)Transitioning High recordHigh − ((recordHigh − 70% recordLow)*0.15)Transitioning Low recordLow + ((recordHigh − 70% recordLow)*0.15)Activated High recordLow + ((recordHigh − 15% recordLow)*0.15) ActivatedLow recordLow 15%

Pad State Determination: The Deactivated and Activated regions comprisethe upper and lower 33% respectfully of the observed values. WhileaverageReading is in the Activated region the pad outputs a PadActivated signal that someone is on the pad. While averageReading is inthe Deactivated region the pad outputs a Pad Deactivated signal thatsomeone is not on the pad. The last region, Transitioning, is ignored inthis step of the logic, but used later to dynamically calibrate to newconditions. Typically the averageReading travels through theTransitioning region quickly to one of the other two.

Dynamic Calibration: In an ideal situation the above stated steps wouldbe sufficient for full pad operation. If this was the case recordHighwould be the tare weight of the mattress and recordLow would representthe weight of the patient plus mattress. During real-world usage, eventssometimes occur which push the recordHigh and recordLow briefly toextremes which do not represent their intended representations. Thiscould results from a staff member remaking a bed and accidentallyleaning too hard on the mattress while tucking in the far corner. Ifthese outlier events were not accounted for, the pad would function fora time, but could slowly become less and less reliable. In order torectify this comment some embodiments the facility uses the Transitionregion calculated earlier to adjust the record values. For every wakecycle in which the averageReading is within the Transitioning region thefollowing adjustments are made:

recordLow=recordLow+((recordHigh−recordLow)/64)

Transitioning region is recalculated form the formulas above

This moves each record value ˜1.5% of their difference towards eachother, narrowing the distance between these values. If a much lower highor much high low is observed than previously these record values willstart to converge until the averageReading is once again within eitherthe Activated or Deactivated region. In some cases this convergence maytake a minute, but it avoids a need for the staff to always manuallyintervene in the calibration process.

In some embodiments, the pad maintains a data connection to the SUREMonitor that enables calibration and region data to be transmitted tothe cloud server for storage and later analysis. As this is a 2-way dataconnection, the cloud server is capable of sending reconfigurationcommands via the monitor to the pad's MCU. This allows the formula andtimings above to be reconfigured on the fly, enabling the usage of padsfor special applications, such as detecting seizures or other medical orbehavioral conditions.

FIG. 2 is a block diagram showing some of the components typicallyincorporated in at least some of the computer systems and other deviceson which the facility operates. In various examples, these computersystems and other devices 200 can include server computer systems,desktop computer systems, laptop computer systems, netbooks, mobilephones, personal digital assistants, televisions, cameras, automobilecomputers, electronic media players, etc. In various examples, thecomputer systems and devices include zero or more of each of thefollowing: a central processing unit (“CPU”) 201 for executing computerprograms; a computer memory 202 for storing programs and data while theyare being used, including the facility and associated data, an operatingsystem including a kernel, and device drivers; a persistent storagedevice 203, such as a hard drive or flash drive for persistently storingprograms and data; a computer-readable media drive 204, such as afloppy, CD-ROM, or DVD drive, for reading programs and data stored on acomputer-readable medium; and a network connection 205 for connectingthe computer system to other computer systems to send and/or receivedata, such as via the Internet or another network and its networkinghardware, such as switches, routers, repeaters, electrical cables andoptical fibers, light emitters and receivers, radio transmitters andreceivers, and the like. While computer systems configured as describedabove are typically used to support the operation of the facility, thoseskilled in the art will appreciate that the facility may be implementedusing devices of various types and configurations, and having variouscomponents.

Configurable Alarm and Warning Conditions

In some embodiments, the facility provides a mechanism that allows staffmembers to configure for each resident the conditions that trigger analarm, and a warning. Examples of such conditions include entireresident weight departing bed and/or chair; partial resident weightdeparting bed and/or chair; weight shift in the lateral dimension in bedor in the depth dimension in a chair; or explicit alarm activation byresident; failure to depart from bed, chair, and/or toilet for more thana threshold length of time; departure from bed/chair/toilet not followedby arrival at bed/chair/toilet within a threshold length of time;departure from room or portion of room; etc.

Per Patient-Type Configurations

FIG. 3 is a user interface diagram showing a sample user interfacepresented by the facility in some embodiments to configure for aparticular user the conditions that will trigger an alarm or warning.The user interface 300 includes information 310 identifying theresident. A staff member user can use interaction table 320 to specifywarning and alarm conditions. In particular, column 321 of the tableidentifies events, many of which are based upon sensor output. For eachevent, the user can check the corresponding box in warning column 322 toincorporate that event as a warning condition for the resident. The usercan similarly check the corresponding box in alarm column 323 toincorporate that event as an alarm condition for the resident. Forexample, it can be seen in rows 332-334 that, in the resident's bed, aweight shift or a partial departure triggers a warning, while a fulldeparture triggers an alarm. Further, row 331 shows that explicit alarmactivation events always result in alarm. Once the user has adjusted thecheckboxes in columns 322 and 323 to reflect the appropriate warningalarm conditions for this resident, the user can activate submit control390 to update the alarm and warning conditions for this resident. Insome embodiments, these settings are also applied to an area of rooms inorder to more efficiently and quickly setup an entire wing or unit in ahealth care facility with better default values.

In some embodiments, the facility permits each room, bed, or resident tobe configured for various monitoring modes, such as fall monitoring,activity monitoring, combined fall and activity monitoring, or standby(monitoring disabled). For residents who are a fall risk, the fallmonitoring mode alerts staff members that such a resident is standing orwalking unassisted, or if sensor readings predict that they areattempting to rise to their feet. Activity monitoring mode monitors fordetrimental activities and warns staff members when they occur. This canhelp staff members, for example, reduce the likelihood of decubitusulcers by warning when a resident has been sitting too long, or has beenlying in the same position for an extended period of time. In anindependent living scenario, this same activity monitoring can be usedto determine unusual resident activity such as a resident getting up inthe middle of the night for a bathroom visit, but not returning to bedafter 20 minutes. In a rehabilitation center, this mode can be used tonotify staff of those residents who are spending too much time sittingor lying around when they should be up and about. In these scenarios,the facility uses threshold warnings in which a staff member sets atimer for either activity or lack of activity; if the timer expires, astaff member is warned. Staff can also enable a second tier warning thattriggers after additional time from the first timer. For example, astaff member may set a primary timer to alert if a pressure injurypatient sits for more than 2 hours. A secondary escalated warning can beset to activate at 1.1× the original timer—or 12 minutes after the 2hours—if not attending to correctly from the first warning.

The facility also or instead permits staff members to interact withphysical controls to configure a particular monitor assigned to aresident to the particular needs of that resident. For example, in someembodiments, each monitor has a set of physical controls—such as a DIPswitch array inside the monitor's battery cover—that allows for theconfiguration of settings such as alert delay, voice playback enabled,bed/floor pad toggle, latching/nonlatching alarms, tone selection,volume level, etc. In some embodiments, the facility permits staffmembers to override these physical controls via a computing system, suchas via web site. This can be done for individual rooms or beds, or forgroups of rooms or beds. In some embodiments, the facility logs thesemodifications, making them traceable to the user who made the change.

FIG. 4 is a display diagram showing a sample user interface presented bythe facility in some embodiments to permit a staff member to centrallycontrol the settings on one or more monitors. In the user interface 400,an area name control 401 enables the user to identify an area of thehealth care facility whose monitors are affected by the monitor settingchanges made using the user interface. The user interface furtherincludes a devices configuration heading 402 under which deviceconfigurations can be changed. The user interface further includes amonitor heading 403 under which monitor settings can be altered. Theuser interface further includes control 404 that can be used to specifya mode in which the pad is to operate; in some embodiments, theseinclude: (1) Fall Monitoring—intended for individuals classified as afall risk by the care facility. All sensors are actively monitored formovement and recorded. Departure from a surface without a staff member'sassistance, or other similar sensor indicated risky movements, willresult in an alert being generated and sent to devices carried by staffmembers. This mode also includes the additional Activity Monitoringitems below; (2) Activity Monitoring—intended for individuals notclassified as a fall risk and therefor does not produce surfacedeparture alerts to staff members. Sensor data is monitored and recordedfor movement recording and trending purposes, primarily to be used togenerate warnings for staff members of undesirable situations (e.g. in achair too long which could be causing skin breakdown, detection ofrestless sleep, etc.). This mode can also be used to provide betterindividualized care as patterns can be identified which assist staffmembers in better times for toileting, check-ins, meals, etc.; and (3)Standby—intended to completely disable the monitoring and recording ofsensor data. No alerts or warnings will be generated from this monitor.This mode allows the monitor to remain plugged in when not needed whichhelps maintain the integrity of the mesh data network.

The user interface further includes a pad type control 405 that can beused to specify the type of pad deployed, such as “Bed Pad,” “FloorPad,” or “Chair Pad.” The user interface further includes a control 406that can be used to specify whether, for each of the monitors in thearea identified by the user using the area name control, the tab isdisabled; a control 407 that can be used to specify whether the alarmsare latching or nonlatching; a control 408 that can be used to specify aperiod of time before the alert is signaled; and a control 409 that canbe used to specify the type of alert that is to be signaled. The userinterface further includes a save control 410 to save the settingchanges made using the user interface, and a cancel control 411 tocancel the setting changes made using the user interface.

Inferred Alarm and Warning Conditions

FIG. 5 is a flow diagram showing a process performed by the facility insome embodiments to automatically infer alarm states and/or warningstates from data received about the resident from sensors of a varietyof types. In act 501, the facility accesses sensor outputs for theresident, such as those collected from one or more monitors by the localserver. In act 502, the facility applies inference rules to sensoroutputs in order to obtain inferred alarm and/or warning states. In act503, the facility creates alarms and/or warnings for the resident basedupon the states inferred in act 502. After act 503, this processconcludes.

Those skilled in the art will appreciate that the acts shown in FIG. 5and in each of the flow diagrams discussed below may be altered in avariety of ways. For example, the order of the acts may be rearranged;some acts may be performed in parallel; shown acts may be omitted, orother acts may be included; a shown act may be divided into subacts, ormultiple shown acts may be combined into a single act, etc.

As one example, the facility observes a particular resident over thecourse of 30 days to identify the following behavioral baseline:

-   -   Resident is in bed at night 7 hours 35 minutes (±14 minutes)    -   Resident wake up 6 times (±1) per night.    -   Resident gets out of bed 2 times (±1) per night for 4 minutes        (±3 minutes)

Once the facility establishes this baseline, in some embodiments itdraws the following inferences from the following further observation ofthis resident:

-   -   Resident gets up 11 times in the middle of the night (83%        increase from normal).    -   Resident average time in bed per night has dropped 4% night        after night for 4 nights. Last night's time in bed was only 5        hours 52 minutes: infer sleep disorder, and inform nurses.    -   As of 2 am resident has woken up 16 times (166% increase over        typical full night). Warn nurses something is keeping the        resident from sleeping soundly (pain related, new medication,        etc.)

FIG. 6 is a flow diagram showing a process performed by the facility insome embodiments to use machine learning techniques to associate sensoroutputs proximate in time to explicit alarms with inferred alarm states.In act 601, the facility accesses information about alarms and/orwarnings created for a resident, such as information about alarms and/orwarnings stored on the local server. In act 602, the facility accessessensor outputs for the resident that are proximate in time to thecreated alarms and warnings whose information was accessed in act 601.In act 603, four sensor outputs having strong correlation to the alarmsor warnings, the facility creates inference rules that infer the alarm awarning from the correlated sensor outputs. After act 603, this processconcludes.

In some embodiments, the facility predicts an imminent resident needusing a pattern from a single sensor over a period of time; in someembodiments, the facility uses a pattern observed among an array ofsensors, including such sensors as pressure pads in beds, chairs,wheelchairs, and sofas; door contact sensors on exterior doors, bedroomdoor, and bathroom door; and motion sensors in major travel areas.

An example of using patterns in data from a single sensor to predictimminent resident need involves a multiple-zone bed pressure pad sensor,which can detect where a patient is in the bed and how they are movingaround. This sensor splits the width of the bed into section with eachsection reporting its relative pressure. By observing the pattern of thedata from these sections, the facility makes predictions for a patientgetting into bed, restlessness, turning or lack thereof, and movementindicative of imminent bed exit as follows:

-   -   1. Gets into bed from the right side sitting on the edge.    -   2. Lays down into the middle of the bed.    -   3. Rolls to the far left side of the bed.    -   4. Rolls back to the middle and begins to fidget    -   5. Exits the bed on the right side        Between events 4 and 5, the facility uses prior patterns of        observations to predict the resident's exit, and alerts staff        members to attend to the resident.

In some embodiments, the facility is used in conjunction with a processfor issuing visitor badges to visitors. In various embodiments, thisbadge-issuing process is automatic, semi-automatic, or manual. Accordingto the process, when a visitor arrives to visit a particular resident,the resident and visitor's identity are recorded, together with thearrival time. The visitor is issued a badge that visually identifies thevisitor, including in some cases an identification of the resident beingvisited, the arrival time, visitor's name, visitor's photo, etc. In someembodiments, the badge or a holder in which the badge is placed containsa tracking mechanism, such as an RFID beacon, a Bluetooth low energybeacon, etc.

In some embodiments, the facility identifies some or all of the sensoroutputs for the visited resident during the visit period that are to beignored for purposes of generating an alarm; that are to be ignored forpurposes of identifying resident behavior patterns; or both. In someembodiments, the facility identifies this period based upon the presenceof the tracking device in the patient's room, near the patient's bed,etc. In some embodiments, the facility assumes that the visit will lasta predetermined amount of time after the visitor's arrival, such as twohours. In some embodiments, the process prompts or requires the visitorto check out on exit, and the period is ended at this time. In someembodiments, the facility ignores all sensor outputs during the periodfor one or both purposes. In some embodiments, the facilityautomatically identifies a proper subset of the sensor outputs duringthe period to ignore based on, for example, the specific location and/ormovement patterns of the badge beacon; the typical behavior patterns ofthe resident; observations made by staff members about where the visitoris in the room at certain points; etc.

Silent Dispatch

In some embodiments, the facility responds to an alarm or warningcondition, such as a departure from bed, in a way that summons a staffmember without creating a sensory disturbance for that resident, or forother people nearby, such as by selectively prompting staff membersusing portable devices carried by them. In some such embodiments, thefacility uses portable devices carried by staff members—such assmartphones—to selectively prompt a certain staff member to attend tothe resident who is the subject of the alarm. In some cases, thefacility uses a set of rules to select the staff member who is initiallyprompted, such as by selecting a staff member assigned directly to theresident; a staff member assigned to a physical area where the residentis located, or in which the resident is assigned to reside; a staffmember who is assigned to a certain type of activity; a staff memberwhose present location is nearest the resident; and/or a staff memberwho has gone the longest since handling a tracked action. If theprompted staff member is available to attend to the alarm, s/he can usehis or her portable device to accept the alarm. If the prompted staffmember does not accept the alarm, one or more additional staff membersare summoned. In some embodiments, the facility provides a mechanismthat allows staff members to configure for each resident which staffmembers are summoned for alarms raised for the resident, in some casesdifferently based on the type of the alarm.

In some embodiments, a health care facility organizes its staff using atree hierarchy of nested areas. The top of this tree is a single healthcare facility whose children are defined by the organizational strategyof the health care facility in question. For example, in a tree inparticular a health care facility, the root mode may have four childnodes called wings, each wing having two child nodes called units, eachunit node having four child nodes called bays, and each bay node havingchild nodes called beds. In a simpler instance, a tree health carefacility includes a six root node having units as child nodes, each ofthose unit nodes having rooms as child nodes. This hierarchy of areasallows the device to be assigned at the lowest level—such as rooms—andstaff members to be assigned at any level in the hierarchy.

Utilizing the nested area hierarchy defined above, when an alert isgenerated at a device, the facility assigns that alert to the areaassociated with the device. The facility then begins to look for staffmembers assigned to that area in order to dispatch a request for action.If no staff members are found assigned to that area the area's parent inthe hierarchy is found and the notification system proceeds in a similarmanner. If this parent area also has no staff members assigned itsparent is then found and the process continues until all levels of thehierarchy are exhausted or somebody is able to address the alarm. Inaddition to walking up this escalation hierarchy, in some embodimentsthe facility also uses a three tier system of responder levels. Eachstaff member is assigned a responder level by their administration. In atypical scenario, staff members on the floor responding to alarms areassigned as a first level responder. Unit managers or managers of thefloor staff would be assigned as second level responders. The Directorof Nursing or health care facility wide administrator would be assignedas a third level responder.

In some embodiments, the facility walks up the area hierarchy but foreach step it also progresses through the responder levels from first tosecond to third. This allows upper management to only be notified of analarm if lower level staff have not responded appropriately.

The facility typically relies upon the currently logged in users, thedevices they are using to connect, and the connectivity status of thosedevices. In some embodiments, only those staff members who are logged inand activity connected will be included in the alert escalation systemdescribed above.

In some embodiments, each logged in device checks in with the serversevery 60 seconds. If a device does not check in for 2 minutes, thefacility removes the device and the user logged into that device fromthe list of staff members available for responding to an alarm. Thistypically happens if the device is moved out of Wi-Fi range, but canalso occur due to an Internet outage, an empty device battery, orsomeone turning the device off without logging out. As soon as thedevice resumes its 60 second check-ins, the device and user are returnedto the list of available staff members without requiring the user toreauthenticate.

In the event that no staff members are available to receive an alert(whether due to lack of logins, or all logged in staff members beingbusy), the facility will not have the means to silently call for help onbehalf of the resident. In this scenario, the facility triggers afailsafe mechanism, signaling the monitor in the room to ignore thesilent mode selection and begin to audibly alarm in an attempt to getthe attention of the physically closest staff.

In some embodiments, in the event that no staff members are available toreceive an alert, the health care facility administrator can beconfigured to receive emails, text messages, and/or phone calls. Thiscan help notify health care facility administration that something isamiss at the location.

FIG. 7 is a flow diagram showing a process performed by the facility insome embodiments to perform silent dispatch of a staff member inresponse to a resident alarm or warning. In act 701, the facilitydetects an alarm or warning condition for a resident. In act 702, thefacility uses a response hierarchy, or other rules, to select a staffmember to prompt to accept and respond to the alarm or warning. In act703, the facility uses a portable device of the selected staff member toprompt this staff member to accept the resident's alarm warning. In act704, if the staff member selected in act 703 accepts the alarm orwarning within a threshold period of time, such as 30 seconds, then thefacility continues in act 705, else the facility continues in act 702 toselect another staff member to prompt.

In act 705, the facility prompts the selected staff member to close thealarm or warning once the staff member has checked on the resident andresolved any matters of concern. In act 706, if a configured amount oftime for the prompted staff member to respond has elapsed sinceprompting, then the facility continues in act 702, else the facilitycontinues in act 707. In act 707, if the selected staff member closesthe alarm or warning, then the facility continues in act 708, else thefacility continues in act 706. In act 708, the facility prompts theselected staff member to complete a survey regarding the alarm orwarning and its resolution. In act 709, when the selected staff membercompletes such a survey, the facility continues in act 710. In someembodiments, the facility continues in act 710 even where no survey iscompleted. In act 710, the facility stores details of the alarm warningfor later reference and/or analysis. After act 701, this processconcludes.

FIG. 8 is a user interface diagram showing a sample user interfacepresented by the facility in some embodiments to allow a staff memberuser to specify a hierarchy among the staff for prompting staff membersto respond to resident alarms and warnings. User interface 800identifies several groups of one or more staff members 811-819. For eachof these groups, the user may enter a number indicating the precedenceof this group in the staff prompting cycle for an alarm or warning.Based upon the numbers shown in the drawing, when an alarm warningoccurs, the nursing assistant on duty who is assigned to the resident isprompted first. If this nursing assistant affirmatively declines orfails to accept during the threshold amount of time, then the facilityprompts the nearest nursing assistant, and then other nearby nursingassistants, and so on.

FIG. 9 is a user interface diagram showing a sample user interfacepresented by the facility in some embodiments to prompt a staff memberto respond to an alarm. The user interface 900 includes a prominentindication 910 that the staff members being prompted about a residentalarm. Information 920 identifies the resident and/or area who is thesubject of the alarm, and her location. Indications 931-932 reflect thetype of the alarm, and the time at which it was raised. The staff membermay activate control 941 to accept the alarm, or activate control 942 todecline the alarm. If the staff member does neither for the thresholdamount of time, in some embodiments the facility removes the prompt fromthe display, as the prompt is at this time reassigned by the facility toa different staff member.

Post-Alarm Survey

In some embodiments, after a staff member accepts the alarm, thefacility conducts a survey with the staff member to collect informationabout the alarm and its resolution. In some embodiments, the facilitystores the collected information for further analysis, such as toidentify physical hazards that lead to frequent falls, assess responsetime and other staff performance metrics; infer information about theresident such as bathroom frequency/schedule; referral suggestions inlight of observed resident information; etc.

In some embodiments, after a staff member declines an alarm, that staffmember is marked a busy for the next several minutes. Staff members whoaccept an alarm are also marked as busy until the alarm they accepted isresolved. This allows subsequent alarms to skip these staff members sothat they can complete whatever task they are activity working on withfewer interruptions. This also speeds the process of alarm escalation bytargeting staff members most likely to be available to respond.

FIGS. 10A-10E are user interface diagrams showing a sample userinterface presented by the facility in some embodiments to collectinformation about a resident alarm or warning and its resolution fromthe staff member who responded to the alarm or warning. FIG. 10A shows afirst display 1010 containing a question about why the resident lefttheir bed or chair. The staff member user can select any of reasons1011-1016, which are configurable by the health care facility. Inresponse, the facility transitions to a second display of the userinterface.

FIG. 10B shows the second display 1020 containing a question aboutwhether the resident fell to the floor. The user can select a positiveresponse 1021 or negative response 1022. In response, the facilitytransitions to a third display of the user interface.

FIG. 10C shows the third display 1030 containing a question about thereason for the fall. The user can select any of reasons 1031-1036, ormay enter another reason into box 1037 and activate control 1038. Inresponse, the facility transitions to a fourth display of the userinterface.

FIG. 10D shows the fourth display 1040 containing a question aboutwhether the resident was injured when s/he fell. The user can select apositive response 1041 or negative response and 42. In response, thefacility transitions to a fifth display of the user interface.

FIG. 10E shows the fifth display 1050 containing a summary of theresponses to the survey's questions. If the listed information isaccurate, the user can activate a submit control 1051 in order tocomplete the survey. If any information is inaccurate, the user canactivate a back control 1052 to revise his or her responses.

Per-Patient Alarm Attributes

In some embodiments, the facility provides a mechanism that allows staffmembers to configure alarm attributes for each resident. Examples ofsuch attributes are silent/audible; visible/non-visible; volume level;duration; sound type; speech/non-speech; etc.

FIG. 11 is a user interface diagram showing a sample user interfaceprovided by the facility in some embodiments to enable staff member userto configure alarm attributes for a particular resident. The userinterface 1100 includes identifying and location information 1110 forthe resident. It further lists alarm attributes 1121-1128, which theuser may select for the user. For example, as shown, silent alarms areselected for this resident, and visible alarms are also selected.

Timeline View of Alarms

In some embodiments, the facility provides a visual user interface thatshows the alarms (or warnings, or alarms and warnings) that haveoccurred over time relative to a timeline. In various embodiments, theseare for a single, selected resident; a group of residents, such as thosewho reside in a particular area of the health care facility, or are in aparticular category of residents based on, for example, their careneeds; or all of the residents in the health care facility. In somecases, certain types of alarms (and/or warnings) are shown in their owncolor or pattern. In some embodiments, a staff member can click on apoint in the timeline view to display additional detail about the alarmsand warnings to which that point relates.

FIG. 12 is a user interface diagram showing a sample user interfaceprovided by the facility in some embodiments to show the timing ofalarms and/or warnings in a particular health care facility or area of ahealth care facility. The user interface 1200 includes a heading 1201indicating that the user interface shows the timing of alarms thatoccurred in a “Wing C” area of a health care facility on Aug. 15, 2017.The user interface shows a timeline 1210 representing the span of timeduring that day, and contains stacks of rectangles such as stack 1211 atvarious points on the timeline showing alarms that occurred at thattime. Taller stack reflect larger numbers of alarms at the same time. Insome embodiments, the facility causes certain rectangles to have colors,patterns, etc. reflecting different alarm attributes, such as alarmtype, alarm resolution type, alarm resolution time, alarm versuswarning, etc. In some embodiments, the user can select a rectangle orstack rectangles to display more detailed information about thecorresponding alarm or group of alarms.

FIG. 13 is a user interface diagram showing a second sample userinterface provided by the facility in some embodiments to show thetiming of alarms, warnings, and special or other types of events thatoccur in a particular health care facility or area of a health carefacility. The user interface 1300 shows a per-room timeline viewreflecting what occurs in each of multiple rooms over the course of aperiod of time, such as a day. Timeline 1350 for the resident in room107P shows that this resident had a very restful morning with nointerruptions, and woke about 7:30 a.m. On the other hand, timeline 1360for the resident in room 501A shows that this resident had a veryrestless night with many sleep interruptions, many of which areaccompanied by bed exists that lasted several minutes before returningto bed. Timeline 1370 shows activity in room 5088, which is havingsensor hardware or sensor network issues, as it has not maintained areliable data connection for the majority of the day shown. In someembodiments, in response, the facility generates a trigger for staff toinvestigate this issue.

FIG. 14 is a user interface diagram showing a third sample userinterface provided by the facility in some embodiments to show thetiming of alarms, warnings, and special or other events in a particularhealth care facility or area of a health care facility. In userinterface 1400, events are aggregated across a group of rooms, such asall of the rooms in a health care facility, across the course of a day.This can be effective to identify peak time of the day for alerts, anddetermining what number of these were attended by staff as opposed toresidents returning to a bed or chair on their own.

Resident Behavior Cues

In some embodiments, the facility provides a mechanism that allows staffmembers to configure voice behavior cues for each resident to suggestactions to him or her, such as “wait by the bed” or “use your walker.”

FIG. 15 is a user interface diagram showing a sample user interfaceprovided by the facility some embodiments to enable a staff member userto configure a voice behavior Q4 particular resident. User interface1500 includes information 1510 identifying the resident and herlocation. It further includes a field 1520 into which the user can entera voice behavior cue to be issued to the resident in certaincircumstances, such as when she departs her bed. In some embodiments,the facility uses a text-to-speech capability of the monitor device tooutput this voice cue to the resident. In some embodiments (not shown),a particular resident's monitor device stores passages of speechrecorded specifically for this resident, such as by a relative of theresident. In such embodiment, this user interface shows a summary ortranscription of each of these passages, and allows the user to selectamong them. After specifying the voice cue for the resident, the useractivates a submit control 1590 in order to complete the configuration.

Patient and Staff Member Location Tracking

In some embodiments, the facility tracks the physical location of someor more residents, such as by performing trilateration with respect to aradio beacon broadcast by a transmitter embodied in an object worn by aresident, such as using radio receivers such as those incorporated intomonitor devices. In some embodiments, the facility also uses radiorepeaters for this purpose. In some embodiments, the facilityrecurringly compares each resident's location to regions of the healthcare facility in which the resident should or should not be present, anduses the results of these comparisons to generate alarms or warningswhere the resident has departed a region in which s/he should be presentor is on a path to do so, and/or where the resident has entered a regionin which s/he should not be present or is on a path to do so.

Some devices move about the health care facility, including wheelchairfall monitors installed in wheelchairs, and call pendants worn aroundthe neck of residents. Because these devices are mobile they are notassigned to a static location within the health care facility's locationhierarchy. Some embodiment, the facility identifies the location ofthese devices using the wireless radios contained inside of them. Whenan alarm is generated, the data is sent to the server for processing anda local radio broadcast is sent to all mesh devices in the immediatearea in order to determine approximate distances. The associatedstatically-assigned device ids and approximate distances are then sentto the server where an algorithm determines the approximate location ofthe alarming device using trilateration or weighted averagecalculations. This estimated location is then correlated to the healthcare facility map to determine which nested area it is contained within.This allows the system to notify staff members in the immediate vicinityof the alarm instead of sending the message to where the device wasoriginally provisioned. This also provides a marker on the health carefacility map to aid staff members in quickly location the alarm.

In some embodiments, any fall monitor can be configured into either amobile or fixed mode. In the mobile mode, the position of the monitorcan be determined with respect to monitors that are in the fixed mode.In some embodiments, the mode is selected manually by staff members. Insome embodiments, each monitor infers its mode using one or more of avariety of approaches, including such approaches as using anaccelerometer incorporated into the monitor; determining whether themonitor is changing position with respect to most or all of the othermonitors it can observe; whether the device is battery- or wall-powered;etc.

In some embodiments, the facility periodically locates each monitor,call pendant, and other devices used for tracking as a basis formaintaining and/or recording the location of these objects over time.

In some embodiments, the facility uses a trilateralation process todetermine this approximate location. Trilateration is a geometricprocess of determining absolute or relative locations of points bymeasurement of distances, using the geometry of circles, spheres ortriangles. In addition to its interest as a geometric problem,trilateration does have practical applications in surveying andnavigation, including global positioning systems (GPS). In contrast totriangulation, it does not involve the measurement of angles. Intwo-dimensional geometry, it is known that if a point lies on twocircles, then the circle centers and the two radii provide sufficientinformation to narrow the possible locations down to two. Additionalinformation may narrow the possibilities down to one unique location.The facility uses each room's monitor as a center point of a circle todetermine the location of the roaming device (e.g., wheelchair orpendant). The “measurement of distances” happens using the ReceivedSignal Strength Index (“RSSI”) of the wireless radio signal from thesurrounding rooms' monitors.

FIGS. 16A-16F are diagrams showing an additional form of devicelocation-finding used by the facility in some embodiments. FIG. 16Ashows the locations of three fixed location finding points within thehealth care facility, such as points in which there are fall monitorsoperating in fixed mode. These locations are shown as points a₁, a₂, anda₃. In some embodiments, these points correspond to the known locationsof three fall monitors nearest the tracked device, i.e., those that arereceiving the strongest signals transmitted by the tracked device.

FIG. 16B shows a first step of range-finding between the tracked deviceand each of the fixed fall monitors. With respect to fall monitor a₁, itcan be seen that this fall monitor observes a signal strength s₁ of 2.0from the tracked device, which the facility converts to an estimatedradius r₁ of 8 meters. Thus, the facility describes a first arc 1601corresponding to this radius about point a₁. Similarly, the facilitydetermines a signal strength s₂ of 15.6 and an estimated radius r₂ of 4meters for point a₂, causing it to describe arc 1602 about point a₂.Finally, the facility determines a signal strength sa of 4.6 and acorresponding estimated radius r₃ of 6 meters for point a₃, causing itto describe arc 1603 about point a₃s.

FIG. 16C shows the identification of intersection points using thedescribed arcs. For each pair of points among the three points, thefacility describes a line containing these two points. For example,between points a₁ and a₂, the facility describes line 1613. On each ofthese lines, the facility identifies the two points at which an archaving one of these two points as its center intersects the line. Forexample, considering the line defined by points a₁ and a₂, it isintersected by arc 1601 at point b₃, and by arc 1602 at point b₃′.

FIG. 16D shows the process of identifying the midpoint between a pair ofpoints identified in FIG. 16C on each of the sides of the triangle. Itcan be seen that the facility identifies point c₁ as the midpoint ofsegment b₁-b₁′; identifies point c₂ as the midpoint of segment b₂-b₂′;and identifies point c₃ as the midpoint of segment b₃-b₃′.

FIG. 16E shows the determination of another triangle. The facilitydescribes triangle d₁-d₂-d₃ by connecting a₁ to c₁, a₂ to c₂, and a₃ toc₃.

FIG. 16F shows the determination of the center point e for triangled₁-d₂-d₃. In some embodiments, the facility determines the center ofthis triangle as its center of gravity, or “centroid.” In someembodiments, the facility determines the center by averaging thenorth-south location of each of the vertices, and averaging theeast-west location of each of the vertices. Based upon this processing,the facility estimates the location of the tracked device as point e.

FIG. 17 is a flow diagram showing a process perform the facility in someembodiments to track and respond to the location of a resident. In acts1701, the facility uses trilateralation among monitor devices toidentify the location of a tracking device worn by the resident, such asa pendant or bracelet. In act 1702, the facility compares the locationidentified in act 1701 to a set of permitted and forbidden regionsestablished for the resident. For example, the resident's room andbathroom may be permitted regions, and a building exit stairway may be aforbidden region. In act 1703, if the comparison of act 1702 indicatesthat the resident is leaving a permitted region or entering a forbiddenregion, then the facility continues in act 1704, else this processconcludes. In act 1704, the facility creates an alarm or warning for theresident reflecting of their leaving of a permitted region or entering aforbidden region. After act 1704, this process concludes.

In some embodiments, the facility tracks the physical location of staffmembers in the same or similar ways—using mobile devices carried bystaff members, RFID badges worn by staff members, etc.—such as tomonitor their performance of rounds, alarm and warning responses, andother responsibilities that involve movement through the health carefacility. In some embodiments, the facility uses various types ofinteractions by staff members with monitor devices, such as pressing abutton on the monitor device, passing near the monitoring devicecarrying a wireless-enabled portable device such as one activelyobserving or broadcasting the Bluetooth Low Energy (“BLE”) protocol;receiving location determined by the portable device using GlobalPositioning System (“GPS”) or Indoor Positioning System (“IPS”),affirmative room check-in using an app running on the portable device,or some combination of some or all of these.

In some embodiments, the location-tracking of staff members is used bythe facility as a basis for assigning alerts to staff members, such asby assigning an alert for a particular location first to the neareststaff member, then to the second-nearest staff member, etc.

In some embodiments, the alarm may be prevented entirely by combiningmonitor status with staff location. For example, if a staff member islocated in the room and by the bed at the time of a bed alarm, in someembodiments the facility infers that the staff member is activelyworking with the resident in the room. In some embodiments, in makingthis inference, the facility relies on on-body detection by the devicebeing carried by the staff member to reduce the possibility that adevice accidentally left behind will cause valid alarms to inadvertentlybe suppressed.

Health Care Facilities

In various embodiments, the facility operates in health care facilitiesof a variety of types, including, for example, nursing homes, carehomes, hospitals, hospice centers, birthing centers, prison health carecenters, independent living centers, rehabilitation centers, etc.

Home Use

In some embodiments, a version of the facility is adapted for home use,such as on behalf of an aged or unhealthy person who lives alone, or isotherwise at home alone during extended periods. In some embodiments,when the facility identifies an alarm, it dispatches it to peopleoutside the home, such as the person's children, neighbors, friends, orclergy. These alarms may be via text message, email message, telephonecall using a recorded or synthesized voice, facsimile message,smartphone app, etc. In some embodiments, some or all of these ad hoccaregivers can access reports and event histories generated by thefacility for the monitored person, such as via the public web, in somecases subject to authentication and/or secure transmission protocols.

CONCLUSION

It will be appreciated by those skilled in the art that theabove-described facility may be straightforwardly adapted or extended invarious ways. While the foregoing description makes reference toparticular embodiments, the scope of the invention is defined solely bythe claims that follow and the elements recited therein.

1-38. (canceled)
 39. A method in a computing system, the method beingperformed in a residential health care facility, the method comprising:in a mobile sensor device that generates information about a state of aperson to whom the sensor is assigned: transmitting a signal in whichthe generated information is encoded; in each of two or more monitoringdevices each having a known location in the residential health carefacility: receiving the signal transmitted by the sensor device;determining an indication of a strength at which the received signal wasreceived; transmitting to a server one or more messages collectivelycontaining a representation of the generated information encoded in thereceived signal and the determined indication of the strength at whichthe received signal was received; in the server: receiving the messagestransmitted by monitoring devices; using the representation of thegenerated information to determine that the mobile sensor device is inan alarm state; using the strength indications in the received messagestogether with the known locations of the monitoring devices to predict alocation in the residential health care facility of the mobile sensordevice; dispatching an alarm to a caregiver in a way that reflects thepredicted location.
 40. The method of claim 39 wherein the mobile sensordevice is a pressure sensor that generates information about departureof a person from a wheelchair presently bearing the mobile sensordevice.
 41. The method of claim 39 wherein the dispatching reflects thepredicted location by explicitly identifying the predicted location. 42.The method of claim 39 wherein the dispatching reflects the predictedlocation by selecting a caregiver to whom to dispatch the alarm who ispredicted to be near the location predicted for the mobile sensordevice.
 43. The method of claim 42, further comprising: in the server:using information originated by a mobile device carried by the selectedcaregiver to predict that the selected caregiver is near the locationpredicted for the mobile sensor device.
 44. The method of claim 43,further comprising: in the server: receiving the information originatedby the mobile device from the mobile device.
 45. The method of claim 43,further comprising: in the server: receiving the information originatedby the mobile device from each of one or more monitoring devices. 46.The method of claim 43 wherein the mobile device is a smart phone. 47.The method of claim 43 wherein the mobile device is an identificationbadge.
 48. One or more computer memories collectively having contentsconfigured to cause a computing system to perform a method for managingone or more resting place departure monitoring devices in a residentialfacility, the comprising: causing to be displayed on a dynamic displaydevice: visual information identifying one or more selected monitoringdevices in the residential facility, and controls each corresponding toa configuration setting of the monitoring devices; receiving inputinteracting with one of the displayed controls in order to change one ofthe monitoring device configuration settings; in response to receivingthe input, for each of the selected one or more monitoring devices,causing the monitoring device's configuration to be adapted to beconsistent with the changed monitoring device configuration setting. 49.The computer memories of claim 48, the method further comprising:causing to be displayed on the dynamic display device a control forselecting one or more monitoring devices in the residential facility,and wherein the displayed visual information identifying one or moreselected monitoring devices identifies monitoring devices selected usingthe displayed control for selecting one or more monitoring devices. 50.The computer memories of claim 48 wherein, for a distinguished one ofthe one or more monitoring devices, the causing changes theconfiguration of the distinguished monitoring device from beingconsistent with a present state of a physical configuration control onthe monitoring device to being inconsistent to the present state of thephysical configuration control. 51-62. (canceled)
 63. One or moreinstances of computer-readable medium collectively having contentsconfigured to cause a computing system to perform a method forpredicting the location of a radio broadcasting device, the methodcomprising: for each of three known locations: receiving an indicationof a strength at which a radio broadcast by the device is received atthe location; using the indicated strength to estimate a range from thelocation of the device; determining at least a portion of a circle aboutthe location whose radius is the estimated range; for each pair of thethree locations: determining a line that passes through both locationsof the pair; for each location of the pair, determining a point at whichthe determined line intersects with the at least a portion of a circledetermined about the location; determining a center point between thedetermined points; defining a line containing the determined centerpoint and the location not among the pair of locations; determining atriangle formed by the intersection of the defined lines; determining acentroid of the determined triangle; and predicting that the device islocated at the determined centroid.